Healthcare Provider Details
I. General information
NPI: 1801893433
Provider Name (Legal Business Name): CAROLYN A GAYLE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X
II. Dates (important events)
Enumeration Date: 06/28/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1 LYONS ST
DEDHAM MA
02026-5599
US
IV. Provider business mailing address
PO BOX 9120
DEDHAM MA
02027-9120
US
V. Phone/Fax
- Phone: 781-329-1400
- Fax: 781-278-5667
- Phone: 781-329-1400
- Fax: 781-278-5667
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 208000000X |
| Taxonomy | Pediatrics Physician |
| License Number | 44999 |
| License Number State | MA |
VII. Legacy identifiers
For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:
| # 1 | |
| Identifier | 70067 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | HARVARD PILGRIM POS |
| # 2 | |
| Identifier | 733890 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | TUFTS |
| # 3 | |
| Identifier | 733890 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | TUFTS COMMONWEALTH PPO |
| # 4 | |
| Identifier | J10294 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | MEDICARE |
| # 5 | |
| Identifier | 0119539 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | MASS HEALTH |
| # 6 | |
| Identifier | 27407 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | CHILDREN'S MEDICAL SEC. |
| # 7 | |
| Identifier | 733890 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | TUFTS TOTAL HEALTH PLAN |
| # 8 | |
| Identifier | J10294 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | BS-BLUE CARE ELECT |
| # 9 | |
| Identifier | 0016059 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | NEIGHBORHOOD HEALTH PLAN |
| # 10 | |
| Identifier | J10294 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | HMO BLUE/BLUE CHOICE |
| # 11 | |
| Identifier | 1494141 |
| Identifier Type | OTHER |
| Identifier State | MA |
| Identifier Issuer | HEALTHSOURCE |
| # 12 | |
| Identifier | 70067 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | HARVARD PILGRIM PPO |
| # 13 | |
| Identifier | 1494141 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | CIGNA HEALTH CARE |
| # 14 | |
| Identifier | 70067 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | HARVARD/PILGRIM |
| # 15 | |
| Identifier | E60222 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | FIRST SENIORITY |
| # 16 | |
| Identifier | 12-40536 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | UNITED HEALTHCARE(PPO) |
| # 17 | |
| Identifier | 733890 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | TUFTS BENEFIT ADMIN |
| # 18 | |
| Identifier | J10294 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | BLUE SHIELD-INDEMNITY |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
